Rituximab through health insurance: the ANS failure that you need to know how to deal with скачать в хорошем качестве

Rituximab through health insurance: the ANS failure that you need to know how to deal with

Please note that when health insurance plans refuse to cover rituximab, claiming that it is only included in the ANS List for certain cases, they may be committing an illegal act! And, in this video, Elton Fernandes, a professor of Medical and Hospital Law at USP in Ribeirão Preto, a lawyer specializing in health insurance plans, explains why. Watch and understand: Rituximab has always been part of the mandatory coverage of health insurance plans, according to the ANS List for: Oncological treatment (cancer) Hospitalized patients, as long as the disease was covered in the drug's package insert In 2023, the National Supplementary Health Agency (ANS) also included rituximab in the list for the treatment of vasculitis, which generated confusion and abuse on the part of insurance companies. Since this inclusion, many insurance companies have started to claim that they are only required to cover rituximab for vasculitis, which is not true. So, is it illegal for a health plan to deny rituximab coverage based on the ANS list? Yes! This is because the Health Insurance Law (Law No. 9,656/98) determines that: All treatments that are in accordance with science must be covered by health plans, even if they are not on the ANS List. The ANS List is a minimum reference, not a maximum coverage limit. In other words: if your doctor prescribed rituximab for a disease that is not on the ANS list, but that is scientifically proven, the health plan cannot deny coverage! Therefore, if the health plan denies rituximab, you must: 1️⃣ Request the denial in writing: the health plan must formally inform you of the reason for the denial. 2️⃣ Request a detailed medical report: your doctor must justify the need for rituximab in your case. 3️⃣ Seek a lawyer who specializes in health insurance plans: this professional can file a lawsuit to seek the supply of the medication. 4️⃣ Request a preliminary injunction in court: a quick decision can force the provider to supply the medication immediately. Important: The lawsuit can be filed entirely online, without the need for travel or in-person hearings. And the plan is corporate? Even if your plan is corporate, the lawsuit is filed against the provider, without involving the company where you work. If your treatment was denied, you can fight for your rights and obtain rituximab through the health insurance plan, even for treatments not covered by the ANS list! 📢 SHARE this video! Many people are unaware of their rights and may be harmed by illegal denials. 🔔 Follow our social media for more information about your rights and how to deal with abusive refusals by health insurance plans! #healthplan #patientrights #rituximab #oncologytreatment #ANS #denialofcoverage #healthrights #justice #eltonfernandes Learn more about rituximab coverage by health plans on our blog: https://eltonfernandes.com.br/planos-... To access the ANS list of procedures, you must click on the link below that will take you to RN 465/2021 and, within this rule, you will look for "Annex II" and enter the name of the medication, treatment or disease, as informed in video: https://www.ans.gov.br/component/legi... The information provided here is general information and does not replace the analysis of the case, with specific particularities, by a specialized lawyer, so that you are informed about the possibilities and risks of your case. To learn more about these subjects, follow our website and social networks: ▷ Website: https://www.eltonfernandes.com.br ▷ Instagram:   / eltonfernandesadvogados   The office of lawyer Elton Fernandes is registered with the OAB/SP under number 16,616 and specializes in lawsuits against health plans, SUS, Medical and Hospital Law, insurance, etc.